Summary
An understanding of the hemodynamics of cerebrovascular spasm following subarachnoid hemorrhage is important for the diagnosis and treatment of this potentially dangerous condition. An overview model is presented which includes the main elements determining the overall effect of vasospasm. The model included realistic pressureflow-velocity-diameter relationships encountered in a geometry resembling that of vasospasm of the middle cerebral artery. Viscosity was adjusted to that expected of human blood. Furthermore, a realistic model the cerebral autoregulation was included. The effects of induced hypertension as well as hypotension were studied.
It was found that the friction pressure loss in the spastic segment was 3.5 times as high as that predicted by using the Hagen-Poiseuille formula. The reason for this discrepancy was probably the ‘inlet length effect’ considerably increasing the friction. Furthermore, including the Bernoulli kinetic pressure energy, a formula was proposed that accurately described the experimental data.
From this hemodynamic perspective, strong support was found for the present trend to use aggressive hypertensive therapy in patients with vasospasm. The results also confirmed that TCD velocity measurements in the spastic segment when taken alone may not be a good index of the degree and effect of the spasm. These measurements must be combined with other techniques such as extracranial Doppler or CBF to assess the degree of spasm.
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References
Aaslid R, Lindegaard K-F, Sorteberg W, Norries H (1989) Cerebral autoregulation dynamics in humans. Stroke 20: 45–52
Aaslid R, Huber P, Nornes H (1985) A transcranial Doppler method in the evaluation of cerebrovascular spasm. Neuroradiology 28: 11–16
Aaslid R, Markwalder T-M, Nornes H (1982) Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries. J Neurosurg 57: 769–774
Aaslid R, Newell DW, Stooss R, Sorteberg W, Lindegaard K-F (1991) Assessment of cerebral autoregulation dynamics from simultaneous arterial and venous transcranial Doppler recordings in humans. Stroke 22: 1148–1154
Aaslid R, Nornes H (1984) Musical murmurs in human cerebral arteries after subarachnoid hemorrhage. J Neurosurg 60: 32–36
Berguer R, Hwang NHC (1973) Critical Arterial Stenosis: a theoretical and experimental solution. Ann Surg 180: 39–50
Clyde BL, Resnick DK, Yonas H, Smith HA, Kaufmann AM (1996) The relationship of blood velocity as measured by transcranial Doppler ultrasonography to cerebral blood flow as determined by stable xenon computed tomographic studies after aneurysmal subarachnoid hemorrhage. Neurosurgery 38: 896–905
Ekelund A, Saveland H, Romner B, Brandt L (1996) Is transcranial Doppler sonography useful in detecting late cerebral ischaemia after aneurysmal subarachnoid hemorrhage? Br J Neurosurg 10: 19–25
Eskridge JM, Newell DW, Pendleton GA (1990) Transluminal angioplasty for treatment of vasospasm. Neurosurg Clin N Am 1:387–399
Giller CA, Bowman G, Dyer H et al (1993) Cerebral artery diameters during changes in blood pressure and carbon dioxide during craniotomy. Neurosurgery 32: 737–742
Heistad DD, Kontos HA (1983) Cerebral circulation. Handbook of physiology: the cardiovascular system III: 137–182
Holen J, Aaslid R, Landmark K, Simonsen S (1976) Determination of pressure gradient in mitral stenosis with a noninvasive ultrasound Doppler technique. Acta Med Scand 199: 455–460
Hussain AKMF (1977) Mechanics of pulsatile flows of relevance to the cardiovascular system. In: Hwang NHC, Normann NA (eds) Cardiovascular flow dynamics and measurements. University Park Press, Baltimore, pp 609–614
Kee DB, Wood JH (1984) Rheology of the cerebral circulation. Neurosurgery 15: 125–131
Kontos HA (1989) Validity of cerebral arterial blood flow calculations from velocity measurements. Stroke 20: 1–3
Larsen FS, Olsen KS, Hansen BA, Paulson OB, Knudsen GM (1994) Transcranial Doppler is valid for determination of the lower limit of cerebral blood flow autoregulation. Stroke 25: 1985–1988
Lassen NA (1959) Cerebral blood flow and oxygen consumption in man. Physiol Rev 39: 183–238
Lewis DH, Newell DW, Winn HR (1997) Delayed ischemia due to cerebral vasospasm occult to transcranial Doppler. An important role for cerebral perfusion SPECT. Clin Nucl Med 22: 238–240
Lindegaard K-F, Nornes H, Bakke SJ, Sorteberg W, Nakstad P (1989) Cerebral vasospasm diagnosis by means of angiography and blood velocity measurements. Acta Neurochir (Wien) 100: 12–24
Martin NA, Patwardhan RV, Alexander MJ, Africk CZ, Lee JH, Shalmon E, Hovda DA Becker DP (1997) Characterization of cerebral hemodynamic phases following severe head trauma: hypoperfusion, hyperemia, and vasospasm. J Neurosurg 87: 9–19
Martins AN, Kobrine AI, Larsen DF (1974) Pressure in the sagittal sinus during intracranial hypertension in man. J Neurosurg 40: 603–608
McDonald DA (1960) Blood flow in arteries. Edward Arnold, London, pp 17–48
Meixensberger J, Hamelbeck B, Dings J, Ernemann U, Roosen K (1996) Critical increase of blood flow velocities after subarachnoid haemorrhage: vasospasm versus hyperaemia. Zen-tralbl Neurochir 57: 70–75
Newell DW, Aaslid R, Lam A, Mayberg TS, Winn HR (1994) comparison of flow and velocity during dynamic autoregulation testing in humans. Stroke 25: 793–797
Nornes H, Knutzen HB, Wikeby P (1977) Cerebral blood flow and aneurysm surgery part 2: induced hypotension and autor-egulatory capacity. J Neurosurg 47: 819–827
Olinger CP, Wassermann JF (1977) Electronic stethoscope for detection of cerebral aneurysm, vasospasm and arterial disease. Surg Neurol 8: 298–312
Permuti S, Riley RL (1963) Hemodynamics of collapsible vessels with tone: the vascular waterfall. J Appl Physiol 18: 924–932
Romner B, Bellner J, Kongstad P, Sjöholm H (1996) Elevated transcranial Doppler flow velocities after severe head injury: cerebral vasospasm or hyperemia? J Neurosurg 85: 90–97
Schmieder K, Hardenack M, Harders A (1996) cerebral hemodynamics in patients with traumatic subarachnoid hemorrhage-sequential studies with TCD. Acta Neurol Scand [Suppl] 166: 123–127
Spencer MP, Reid JM (1979) Quantification of carotid stenosis with continuous-wave (C-W) Doppler ultrasound. Stroke 10: 263–330
Spetzler RF, Roski RA, Zabramski J (1983) Middle cerebral artery perfusion pressure in cerebrovascular occlusive disease. Stroke 14: 552–556
Strandgaard S, MacKenzie ET, Sengupta D, Rowan JO, Lassen NA, Harper AM (1974) Upper limit of autoregulation of cerebral blood flow in the baboon. Circ Res 34: 435–440
Strandgaard S, Paulson OB (1984) Cerebral autoregulation. Stroke 15: 413–416
Strebel S, Lam AM, Matta B, Mayberg TS, Aaslid R, Newell DW (1995) Dynamic and static autoregulation during Iso-flurane, desflurane and propofol anesthesia. Anesthesiology 83: 66–76
Tiecks FP, Lam AM, Aaslid R, Newell DW (1995) Comparison of static and dynamic autoregulation measurements. Stroke 26: 1014–1019
Willis T (1664–1964) The anatomy of the brain and nerves. In: Feindel W (ed) Tercentenary edition. McGill University Press, Montreal
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Aaslid, R. (1999). Hemodynamics of Cerebrovascular Spasm. In: Langmoen, I.A., Lundar, T., Aaslid, R., Reulen, HJ. (eds) Neurosurgical Management of Aneurysmal Subarachnoid Haemorrhage. Acta Neurochirurgica Supplements, vol 72. Springer, Vienna. https://doi.org/10.1007/978-3-7091-6377-1_4
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DOI: https://doi.org/10.1007/978-3-7091-6377-1_4
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